Executive function subdomains are associated with post-stroke functional outcome and permanent institutionalization.

BACKGROUND AND PURPOSE: Impairment of executive functions (EFs) is a common cognitive symptom post-stroke and affects independence in daily activities. Previous studies have often relied on brief cognitive tests not fully considering the wide spectrum of EF subdomains. A detailed assessment of EFs was used to examine which of the subdomains and tests have the strongest predictive value on post-stroke functional outcome and institutionalization in long-term follow-up. METHODS: A subsample of 62 patients from the Helsinki Stroke Aging Memory Study was evaluated with a battery of seven neuropsychological EF tests 3 months post-stroke and compared to 39 healthy control subjects. Functional impairment was evaluated with the modified Rankin Scale (mRS) and Instrumental Activities of Daily Living (IADL) scale at 3 months, and with the mRS at 15 months post-stroke. Institutionalization was reviewed from the national registers of permanent hospital admissions in up to 21-year follow-up. RESULTS: The stroke group performed more poorly than the control group in multiple EF tests. Tests of inhibition, set shifting, initiation, strategy formation and processing speed were associated with the mRS and IADL scale in stroke patients. EF subdomain scores of inhibition, set shifting and processing speed were associated with functional outcome. In addition, inhibition was associated with the risk for earlier institutionalization. CONCLUSIONS: Executive function was strongly associated with post-stroke functional impairment. In follow-up, poor inhibition was related to earlier permanent institutionalization. The results suggest the prognostic value of EF subdomains after stroke.

Time-frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia.

BACKGROUND: Time-frequency balanced spectral entropy of electroencephalogram (EEG) and frontal electromyogram (FEMG) is a novel measure of hypnosis during anesthesia. Two Entropy parameters are described: Response entropy (RE) is calculated from EEG and FEMG; and State Entropy (SE) is calculated mainly from EEG. This study was performed to validate their performance during transition from consciousness to unconsciousness under different anesthetic agents. METHODS: Response entropy, SE [S/5 Entropy Module, M-ENTROPY (later in text: Entropy), Datex-Ohmeda Division, Instrumentarium Corp., Helsinki, Finland] and BIS (BIS XP, A-2000, Aspect Medical Systems, Newton, MA) data were collected from 70 patients; 30 anesthetized with propofol 2 mg kg-1, 20 with sevoflurane inhalation, and 20 with thiopental 5 mg kg-1. Loss and regaining of consciousness (LOC, ROC) was tested every 10 s, and sensitivity, specificity, and prediction probability (Pk) were calculated. Behavior of the indices was studied. RESULTS: Sensitivity, specificity, and Pk values for consciousness were high and similar for all indices. During regaining of consciousness after propofol bolus, RE, SE, and BIS values recovered by 81 +/- 22%, 75 +/- 26%, and 59 +/- 18% (mean +/- SD), respectively, from the minimum relative to their baseline. After thiopental bolus, RE, SE, and BIS values recovered by 86+/-21%, 88 +/- 13%, and 63 +/- 14%, respectively. The relative rise was higher in RE and SE compared with BIS (P < 0.01). During deep levels of hypnosis, RE and SE decreased monotonously as a function of burst suppression ratio, while BIS showed biphasic behavior. On average, RE indicated emergence from anesthesia 11 s earlier than SE, and 12.4 s earlier than BIS. CONCLUSIONS: All indices, RE, SE, and BIS, distinguished excellently between conscious and unconscious states during propofol, sevoflurane, and thiopental anesthesia. During burst suppression, Entropy parameters RE and SE, but not BIS, behave monotonously. During regaining of consciousness after a thiopental or propofol bolus, RE and SE values recovered significantly closer to their baseline values than did BIS. Response entropy indicates emergence from anesthesia earlier than SE or BIS.

Mothers' grief following the death of a child.

AIM OF THE STUDY: Research has shown that caring for a dying child is among the hardest and more demanding tasks in nursing, because the staff are forced to manage their heavy work with inadequate skills and experience. This article deals with the findings of a recent study, the purpose of which was to analyse the mother's grief and coping with grief following the death of a child under the age of 7 years. DESIGN: Data were collected from mothers using a survey (n=91) and an interview (n=50). As the topic was very sensitive ethically and emotionally, survey data were collected first and the mothers were asked to give their consent to taking part in an interview. The study employed both quantitative and qualitative methods. The data were analysed using statistical methods and content analysis. However, only the qualitative part of the study is presented in this article. FINDINGS: The findings show that nursing staff had skills to support grieving mothers, but that there were many feelings and experiences of grief that remained unidentified by staff. The staff's ability to meet the mothers' individual needs while the child was in hospital and after the child's death was inadequate. The information received from staff was perceived to be insufficient or offensive to mothers. CONCLUSIONS: The development of basic and further education and of various support measures would enable the staff to better cope with their work. Focusing on interactive skills and meeting the patient's individual needs using reflective practice would improve the quality of care. Communication and collaboration between different occupational groups should be promoted, because mothers were dissatisfied with dissemination of information, and ambiguous responsibilities between different occupational groups hampered the acquisition of information.

Discovery of a comet by its Lyman-alpha emission

Several searches for near-Earth objects have recently been initiated, as a result of increased awareness of the hazard of impacts on the Earth. These programs mainly search for asteroids, so amateur astronomers can still contribute to the discovery of comets, especially out of the orbital plane of the Solar System. An ideal way to search for comets would be to use a spaceborne instrument capable of imaging the whole sky on a daily basis in a systematic and repeatable way. Such an instrument already exists on the solar observatory SOHO; it operates at the Lyman-alpha wavelength of neutral hydrogen, which is the main component of the emission cloud of a comet. Here we report the discovery, using archival data from this satellite, of a hitherto unnoticed comet which reached a perihelion of 1.546 a.u. on 26 June 1997. We derive the water production rate of the comet as a function of time and find that it increases after perihelion, like that of comet Halley.